Get Ready: Changes are Coming to the 2022 FGI Guidelines

By Heather Livingston

The next edition of the Facility Guidelines Institute’s Guidelines documents will be released in early 2022. Written as minimum standards, the Guidelines for Design and Construction of Hospitals; Guidelines for Design and Construction of Outpatient Facilities; and Guidelines for Design and Construction of Residential Health, Care, and Support Facilities are in final review by the Health Guidelines Revision Committee, the 140-person volunteer body responsible for revising the Guidelines.

Updates to the documents were proposed by the public in 2019 and reflect changes in healthcare technology, practice and design. Drafts of the 2022 Guidelines documents were posted for public review and comment from July through September 2020. Through May 2021, the HGRC will review and vote on comments, and those approved will be incorporated into the 2022 edition.

Concurrent with the work of the HGRC, FGI convened a 130-person Emergency Conditions Committee in April 2020. This all-volunteer body of subject matter experts was tasked with writing a comprehensive white paper and new Guidelines requirements to help healthcare organizations plan for a breadth of emergency events. Though the ECC was convened as a response to the COVID-19 pandemic, the white paper will address design and operational considerations for emergencies that are local (e.g., floods, train derailments, mass shooter incidents), regional (e.g., tsunamis, earthquakes, hurricanes) and international (e.g., pandemics and other public health emergencies of international concern) in scale. The white paper will offer guidance on an array of design and operational considerations for health and residential care facilities. As well, the committee will propose changes and additions to the Guidelines documents to support planning and design for resilient facilities that can continue providing care during and after an emergency response. The public will be invited to review this content in early 2021, and some proposed changes may appear in the 2022 edition of the Guidelines.

Planning and Design Guidance for Emergency Conditions

FGI’s Emergency Conditions white paper will include recommended changes to the Guidelines documents in nine topic areas: safety risk assessments, resiliency, surge considerations, rural and/or small health care facilities, residential care settings, renovations and future facilities, alternate care sites and modular construction, and operational considerations.

Because these recommendations for the 2022 Guidelines may establish new minimums, feedback on the proposed changes will be essential. Therefore, the public will be invited to review and comment on the proposed standards this spring. The resulting Emergency Conditions Guidelines are scheduled for release in 2022. To stay informed, sign up for FGI’s newsletter at

Although we don’t yet know which ECC recommendations will be approved for inclusion in the 2022 edition of the FGI Guidelines, other substantial changes are in the works. Recognizing that design can significantly impact patients and residents receiving palliative and end-of-life care, new requirements have been added that support the delivery of these services in hospitals and residential care settings. Similarly, design criteria for the provision of inclusive environments has been added to all three documents, with particular emphasis on supporting patients, residents, staff and visitors with low or declining vision, hearing, mobility, balance or other physical difficulty.

The 2022 Hospital and Outpatient Guidelines will feature two new clinical spaces that have the potential to reduce overcrowding in emergency departments and freestanding emergency facilities. Overcrowded EDs are a common problem in many hospitals, particularly those in urban areas. One strategy that has received considerable support over the last few years is the creation of low-acuity patient treatment stations intended for the “walking well.”

Evidence has shown that low-acuity stations reduce the average length of stay for all patients because ambulatory patients with minor injuries or conditions can be treated without waiting for an available bed. The low-acuity stations have a 40-square-foot minimum clear floor area and provisions for clearances, medical gas outlets, electrical receptacles, nurse call devices, storage, hand-washing stations and privacy. The low-acuity stations are intended to complement single- and multiple-patient treatment rooms; they are not allowed to completely replace ED treatment rooms.

The second clinical treatment space that supports EDs is a behavioral and mental health crisis unit. Behavioral health visits to the ED have been climbing significantly in recent years and are contributing to longer lengths of stay. Due to a chronic shortage of beds in psychiatric care facilities, patients often spend days to weeks in an ED before being admitted. The new behavioral and mental health crisis unit is based on the EmPATH (emergency psychiatric assessment, treatment and healing unit) model and provides an alternative to the ED for medically cleared patients. Patients in the unit receive care in a calm and comfortable environment that features large, open spaces.

The Hospital and Outpatient Guidelines also feature new spaces that support the provision of behavioral and mental health care outside the ED via an intensive outpatient and partial hospitalization program. IOPs provide intense, regular therapy sessions (often three hours a day, three days a week) to support patients recovering from depression, anxiety, substance abuse or other mental and behavioral health diagnoses. PHPs support patients experiencing a relapse of symptoms and those no longer needing inpatient care but still needing substantial step-down support. Unlike patients receiving residential or inpatient treatment, patients treated in IOP/PHPs are not required to spend the night.

Major changes to the Hospital Guidelines include:

  1. Based on recommendations from infection preventionists, hospitals will now be required to conduct an infection control risk assessment when determining whether an anteroom is required for an airborne infection isolation room. A correlating appendix section addresses infection prevention considerations, including storage, space for donning and doffing of personal protective equipment and disposal of PPE. The ICRA will identify the need for and quantity and placement of anterooms.
  2. Minimum design requirements and recommended best practices have been added for burn units and hospice units.
  3. New language has been included to encourage owners, designers and regulators to follow requirements in the critical access chapter (as opposed to the general hospital chapter) when designing small and specialty hospitals with fewer than 50 beds. Revisions to the critical access chapter are focused on increasing flexibility in room use.
  4. The freestanding emergency care facility chapter has been removed from the hospital document and now appears only in the Outpatient Guidelines.
    ECC Proposes Single-Occupancy Minimum in Long-Term Care Facilities

    The residential subcommittee of the Emergency Conditions Committee has proposed a new minimum of single-occupancy resident rooms in new nursing homes, hospice facilities, assisted living facilities, and long-term residential substance abuse treatment facilities. However, the subcommittee has included a provision to allow companion rooms where the need is justified (e.g., to accommodate a couple or siblings who wish to room together).

Major changes to the Outpatient Guidelines include:

  1. A new chapter has been added for extended stay centers for patients receiving care in outpatient surgery centers or freestanding EDs. Patients using extended stay centers are stable and don’t require intensive monitoring or hospital-level care but may not be able to return home the same day due to travel distance, lack of a caregiver at home or more time needed to manage pain. A few states already regulate these facility types and design guidance was needed.
  2. The required size of a birthing room in birth centers has been reduced from 200 to 120 square feet. This change was influenced by a national study of birth centers, which found that 25% of existing birth center rooms were less than 200 square feet.
  3. Other significant changes include revised space requirements based on clearances rather than CFA for certain patient care stations and new provisions for renal dialysis centers to support Centers for Medicare & Medicaid Services requirements, including fluid disposal sinks in hemodialysis treatment areas.

Major changes to the Residential Guidelines include:

  1. Following requests from regulators, an interim amendment to the 2018 Residential Guidelines was released in 2020. Based on that amendment, space requirements for resident rooms in nursing homes now require a minimum CFA of 120 square feet in single-occupancy rooms and 108 square feet per resident in double-occupancy rooms. Likewise, resident rooms for persons of size require a minimum CFA of 200 square feet when an overhead lift is provided and 219 square feet when mobile lifts are used.
  2. A dialysis treatment area been added to the nursing home chapter to support facilities that provide training for home care dialysis.
  3. Patient rooms in hospice facilities are required to have a minimum CFA of 153 square feet to accommodate a family support zone of 33 square feet.
  4. Support for telemedicine services has been considerably enhanced in the Residential Guidelines, and sections on technology, equipment and teledata rooms were updated to reflect current practices.

Finally, a collaborative topic group consisting of HGRC leadership and representatives from the design community, U.S. Army Corps of Engineers and BICSI conducted a thorough review of the Guidelines in an effort to modernize requirements for spaces to accommodate telecommunications systems. Though the content is still under review, these updates are expected to be applied to all three 2022 Guidelines documents. To be notified when the 2022 edition is released, sign up for updates at

Author: Heather Livingston
Heather Livingston is managing editor at Facilities Guidelines Institute.

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Posted December 10, 2020

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